Diffuse cavernous hemangioma of the rectum: evaluation and MRI

Computed tomography (CT) and magnetic resonance imaging (MRI) were used preoperatively to stage the extent of a diffuse rectal hemangioma in a 37-year-old man with recurrent rectal bleeding. On T2-weighted MR scans, the lesion demonstrated a heterogenous signal intensity with large portions displaying the hyperintensity characteristic of hemangiomas of solid organs. MRI did not depict calcified phleboliths evident on CT and barium enema.     

Diffuse cavernous hemangioma of the rectum: an atypical cause of rectal bleeding.

OBJECTIVE: cavernous hemangioma of the rectosigmoid colon is a rare disease, with no more than 200 cases reported in the literature. The rectosigmoid is the most common site of this disease in the gastrointestinal tract. CASE REPORT: we report the case of a 31-year-old male with recurrent episodes of rectal bleeding, who was finally diagnosed of diffuse cavernous hemangioma of the rectum. The tumor, of 12 x 10 x 9 cm in size, occupied the rectum to the margin of the anal sphincter. A surgical procedure was ruled out because of the inability to carry out a safe anastomosis while preserving anal sphincters. DISCUSSION: rectal hemangiomas are less frequent vascular malformations. The clinical presentation of a cavernous hemangioma of the rectum is usually acute, recurrent or chronic rectal bleeding. Other symptoms stem from the possible compression or invasion of adjacent structures, such as lumbar or perianal pain, metrorrhage, hematuria, etc. This diagnosis is commonly made in younger patients. Colonoscopy is without doubt the diagnostic technique of choice, and it allows to establish the localization, morphology, and total extension of the lesion; its characteristic image is a red-purplish nodule with great vascular congestion. According to the opinion of most authors, biopsy is not advisable during colonoscopy, since imaging techniques are sufficient for an accurate diagnosis, and the risk of bleeding while manipulating this lesion is not negligible. Computed tomography and particularly magnetic resonance imaging, given their high precision to delimit the lesion and its relations to adjacent structures, are imaging studies that are mandatory before surgical treatment. Other techniques such as selective angiography, barium enema, gastrointestinal transit, and upper-tract endoscopy may be supplementary and help locate more lesions along the gastrointestinal tract. Failure to recognize the exact diagnosis and extent of diffuse cavernous hemangioma may lead to failed surgical treatment and severe complications. Complete surgical excision of the lesion with a sphincter-saving procedure is the primary mode of treatment: conservative proctectomy with coloanal anastomosis.     

Diffuse cavernous hemangioma of the rectosigmoid colon

Diffuse cavernous hemangioma of the rectosigmoid colon is an uncommon benign vascular lesion. We report 5 cases of diffuse cavernous hemangioma, focusing on the clinical features, diagnosis procedure and treatment. Five patients have undergone sphincter–saving procedures, 3 cases had coloanal sleeve anastomoses and 1 patient each had pull–through anastomosis and lower anterior resection. During the follow–up, which ranged from 3 to 10 years, 3 patients had no further anal bleeding and 2 patients had minor intermittent anal bleeding. Continence for normal stool was satisfactory in all patients. In conclusion, sphincter–saving procedure is most appropriate and curative approach for the treatment of diffuse cavernous hemangioma. Imaging study plays an important role in the diagnosis, preoperative staging and follow–up.     

Diffuse cavernous hemangioma of the rectum: Report of a case and review of the literature

Summary Various aspects of diffuse cavernous hemangioma of the rectum are discussed. The clinical features of chronic rectal bleeding, often beginning in infancy, the proctoscopic findings of fleshy mucosal rectal folds, and the radiologic findings of multiple rectal phleboliths, all serve to establish the diagnosis of this rare disease. Abdominoperineal excision of the rectum is considered by the authors to be the preferred treatment. Cure was achieved in the case reported.     

Diffuse cavernous hemangioma of the rectum: MR imaging with endorectal surface coil and sphincter-saving surgery

We describe the clinical features, diagnostic procedures, and treatment of two patients with diffuse cavernous hemangioma of the rectum. Sphincter-saving operations were performed in both patients, with satisfactory results. Magnetic resonance imaging (MRI) with an endorectal surface coil, as well as a conventional body coil, was used to determine the extent of the hemangiomas. We recommend sphincter-saving surgery for the treatment of this benign disease that can cause life-threatening hemorrhage. MRI with an endorectal coil achieves higher-resolution images than conventional MRI.     

Diffuse cavernous haemangioma complicated with regional osteoporosis

Capillary and cavernous haemangiomas are the most common benign soft tissue tumours of infancy. Cavernous haemangiomas have larger vascular channels and frequently exist in deep dermal tissues. Many haemangiomas require no special treatment. Development of complications such as cardiac failure, malignant change, ulceration and infection are indications for intervention. In this report we present an 11-year-old girl with a pathological fracture after a minimal trauma that might be a result of secondary regional osteoporosis due to diffuse cavernous haemangioma.     

Diffuse cavernous rectal hemangioma—Sphincter-sparing approach to therapy

Diffuse cavernous rectal hemangioma is described through a case history. Presentation, diagnostic work up, pathophysiology, and therapy for this condition are reviewed. Emphasis is placed on rectal sparing surgical techniques in the management of this disease process that affects young, otherwise healthy individuals.     

Diffuse cavernous hemangioma of the rectosigmoid colon with extraintestinal involvement.

Cavernous hemangioma of the colon is a rare cause of gastrointestinal bleeding. These lesions can be encountered as solitary, multiple, or part of a more complex syndrome with cutaneous manifestations. We herein describe a 26-year-old woman with cavernous hemangioma involving the rectosigmoid area. Additional hemangiomas were identified in the pelvic structures, spine, iliac bone and spleen. This multi-visceral involvement without cutaneous manifestations represents an intermediate variety between solitary hemangioma and well-defined syndromes with cutaneous and structural anomalies. The potential presence of extraintestinal hemangiomatosis should be considered and investigated in patients with cavernous hemangioma of the colon even without cutaneous manifestations or with a limited colonic involvement.     

Sphincter-saving procedure for treatment of diffuse cavernous hemangioma of the rectum and sigmoid colon

Two cases of diffuse cavernous hemangioma of the rectum and rectosigmoid colon are reported. Sphincter-saving procedures were applied as the surgical treatment for these two patients. The diseased rectum and distal sigmoid colon were resected 3 cm above the pectinate line. The mucosa of the rectal stump was extirpated. All visible residue from the hemangiomatous tissues on the muscular cuff, pararectal space, and pelvic wall were denuded. The normal colon was then pulled down through the rectal cuff and anastomosed with anoderm, and attached to the internal sphincter muscle. Both patients recovered uneventfully. No uncontrollable hemorrhage was encountered during rectal dissection. Both patients had good anal sensation and perfect continence. No complicated sexual or urinary disturbances were found. The sphincter-saving procedure for treatment of diffuse cavernous hemangioma of the rectum should be promoted and given first choice whenever possible. Read at the Tenth Biennial Congress of the International Society of University Colon and Rectal Surgeons, Strasburg, France, September 1984.     

Cystic cavernous hemangioma of the liver

We report an unusual case of multilocular cystic cavernous hemangioma of the liver. The patient was a 61-year-old woman without liver disfunction but who had multicystic mass lesions in the liver. Although cavernous hemangiomas are usually accurately diagnosed by the various imaging modalities, our case showed atypical features.     

Giant cavernous hepatic hemangioma shrunk by use of sorafenib

Here we report a case of a 76-year-old man with a giant cavernous hepatic hemangioma of more than 20 cm in diameter. Since the hepatic hemangioma was actually growing and might possibly rupture and he complained of abdominal symptoms, we decided to perform interventional therapy. First we performed transcatheter arterial embolization (TAE) of the hepatic arteries. However, since this was not sufficiently effective, we added sorafenib (600 mg/day). As a result, the tumor shrank with symptomatic improvement. Subsequently, an adverse event occurred, and we suspended the sorafenib therapy. Then, the tumor began to grow, and we resumed administering sorafenib at 400 mg/day. The tumor shrank again, and we continued the sorafenib therapy thereafter. The tumor shrinkage, although possibly induced by the effect of TAE, is considered primarily due to the effect of treatment with sorafenib, because (1) TAE did not sufficiently reduce the blood supply to the inside of the tumor; (2) other tumors shrank in the area not targeted by TAE; and (3) the tumor grew during suspension of sorafenib therapy and shrank again after resuming the treatment.     

Cavernous hemangioma of the rectum and rectosigmoid

Summary Hemangioma of the colon and rectum, although a rare condition, can be diagnosed preoperatively if the condition is considered in the light of certain historical and clinical findings. A long history of continuous bleeding in small quantities or episodes of massive rectal bleeding are the outstanding diagnostic features elicited while taking the patient’s history. Suggestive ancillary findings include the appearance of soft, compressible masses in the rectum detectable either by sigmoidoscopy or roentgenologic examination. Phleboliths in unusual locations should arouse suspicion and displacement of the barium-filled small bowel by a pelvic mass gives an indication of the size of the vascular tumor. The expected eventual outcome in untreated or inadequately treated patients is death from massive rectal hemorrhage. It is agreed that surgical removal is the treatment of choice whenever possible; the type of resection depends on the degree and location of the tumor. This paper represents the personal viewpoint of the authors and is not to be construed as a statement of official Air Force policy.     

Giant cavernous hemangioma of liver.

An abscess forming in a giant cavernous hemangioma of the left lobe of the liver is reported. It was treated by lateral segmentectomy.